Managed care package passes in House Feb. 4

Managed care package passes in House Feb. 4 by Andrea Skalland Managed care plans will have to look to the consumer�s best interest in South Dakota, House members voted last week.

The House passed five bills Feb. 4, relating to the issue of managed care plans.

Rep. Kristie Fiegen, R-Sioux Falls, introduced the managed care package to the House saying it was important to address each individual problem rather than treating the whole package the same.

The bills are intended to protect consumers and their rights, she said.

Fiegen told house members that under the bill package, a managed care contractor has to have a medical director present to make decisions about what medical care is needed and appropriate. The director has to have a non-restricted license, meaning no prior marks against his medical practices.

This will ensure that a client will not be turned down for payment or medical treatment

by someone who is not qualified to determine what medical care is needed, she said.

The bills would also allow for a continuation of care. According to Fiegen, under the new legislation if an individual�s doctor were to leave the program, the individual would have 90 days to find a new physician.

Gag orders, which stipulate what the doctor can and cannot prescribe, are also banned. Fiegen said there would also be no financial gain from the companies for doctors to limit care.

A utilization review organization will be instated as well. The organization will ensure that there is a qualified person making decisions and that quality care is being given, Fiegen said. It will check to see that a qualified doctor is making decisions on treatment that has to be pre-authorized.

One other aspect the package looks at is emergency coverage. Fiegen said that if emergency care is needed and the closest hospital is not on the list of providers, the individual can still go there for treatment without a cost penalty.

Rep. Matthew Michels, R-Yankton, urged the body to support this legislation.

�We are often the last state to take action, however here we have a chance to do something

proactive,� Michels said.

Rep. Dana Windhorst, R-Sioux Falls, said that while he did not disagree with protecting people from harm, he felt this was the wrong way to do it.

�We are addressing the problems one by one and not seeing the whole picture,� Windhorst said. �This will move us closer to managed care and closer to having a third person in the doctor�s office with us.�

Windhorst said this provided a false sense of security and will prevent South Dakotans from taking needed action in the future.

Fiegen asked for support on the package saying, �the intention is to help protect citizens across the state.�

House bills 1009, 1010, 1011, 1012 and 1013 passed the House and will now move to the Senate for further consideration.

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